NPIMap

Individual provider Active NPI

Manga Devi Kodali, M.D.

  • Hematology & Oncology Physician
  • Newburgh, IN
National Provider Identifier
1881635118
Registry record updated Jun 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
01072479A Issued in IN
Practice address
4055 Gateway Blvd
Newburgh, IN 47630-8947
Phone
(812) 858-3051
Fax
(812) 858-3060
NPI assigned
Jun 9, 2006
Last updated
Jun 5, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 17645 MS
Internal Medicine Physician 207R00000X ME99614 FL
Hematology & Oncology Physician 207RH0003X 01072479A IN Primary

Addresses

Primary practice location

4055 Gateway Blvd
Newburgh, IN 47630-8947

Mailing address

PO Box 3868
Evansville, IN 47737-3868
Phone (812) 450-6815

Other identifiers 2

IdentifierTypeStateIssuer
00126843MedicaidMS
279823900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130925000885 IN Practitioner - Hematology/Oncology 3173603164 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4055 Gateway Blvd
Newburgh, IN 47630-7451
Phone (812) 858-3051

520 S 7TH St
Vincennes, IN 47591-1038
Phone (812) 885-3280

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
17645MSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Specialty Physicians, Inc Current Accepting new patients
Deaconess Clinic Inc CurrentSince Jul 1, 2013 Accepting new patients
Deaconess Clinic, Inc Hematology & Oncology CurrentSince Jul 1, 2013 Accepting new patients
Deaconess Specialty Physicians, Inc Hematology & Oncology CurrentSince Sep 10, 2021 Accepting new patients
Deaconess Clinic Inc. Internal Medicine Current Accepting new patients
Good Samaritan Hospital Physician Services, Inc Internal Medicine CurrentSince Oct 4, 2023 Accepting new patients
Good Samaritan Hospital CurrentSince Oct 4, 2023 Accepting new patients
Deaconess Specialty Physicians Inc CurrentSince Sep 10, 2021 Accepting new patients
Good Samaritan Hospital Physician Services Inc. Past Accepting new patients

Locations

421 Chestnut St
Evansville, IN 47713
Phone (812) 426-6645

600 Mary St
Evansville, IN 47710
Phone (812) 450-2239

4055 Gateway Blvd
Newburgh, IN 47630
Phone (812) 842-2210

1204 Williams St
Oakland City, IN 47660
Phone (812) 749-6187

1160 E Saint Clair St
Vincennes, IN 47591
Phone (812) 882-1064

520 S 7th St
Vincennes, IN 47591
Phone (812) 885-3280

Interoperability endpoints

  • Direct secure messaging: mkodali65419@direct.deaconess.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370390400000",
    "number": "1881635118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3868",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477373868",
            "telephone_number": "812-450-6815",
            "fax_number": "812-450-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 GATEWAY BLVD",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476308947",
            "telephone_number": "812-858-3051",
            "fax_number": "812-858-3060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KODALI",
        "first_name": "MANGA",
        "middle_name": "DEVI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-09",
        "last_updated": "2013-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "17645",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME99614",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IN",
            "license": "01072479A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00126843",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "279823900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, IN

Sources for this page

Verify at the official NPI Registry.